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Suicide and schizophrenia

 

Clinical bottom line

About 1 in 20 schizophrenics will commit suicide during their lifetimes, usually near illness onset.


Reference


BA Palmer et al. The lifetime risk of suicide in schizophrenia. Archives of General Psychiatry 2005 62: 247-252.


Systematic review

This paper is actually a systematic review, that used a literature search for articles observing cohorts of schizophrenic patients. Searching used two electronic databases (one a specialist psychiatric database), plus extensive bibliographic and reference reviews over 90 years. Studies used diagnostic criteria of their times.

From each of about 60 studies information was collected on number of patients, deaths, suicides, and length of follow up.

Results

Thirty-two studies were composed of any type of patient, and 29 observed schizophrenics from date of admission or illness onset. The studies were as small as a few tens of patients, to over 9,000. Most involved several hundred patients, followed up for two to 22 years.

For the first-admission and new onset studies, the case fatality estimate (percentage of original sample who died by suicide) was 4.9% (95% CI 4.3 to 5.6%). About 31% of the deaths were deaths by suicide. Among the mixed samples the case fatality estimate was 2.3% (1.5 to 3.5%) and 6% of the deaths was by suicide.

Analysis of data by time of follow up suggested that suicide risk was greater sooner rather than later after diagnosis or onset.

Comment

This is a really interesting paper, one rather different from the norm. It would make useful reading for those interesting, or involved with, suicide and schizophrenia.